La OMS puso fin a la ESPII por COVID-19 el 5 de mayo de 2023. [4] La enfermedad ha seguido circulando, pero a partir de 2024, los expertos no estaban seguros de si todavía era una pandemia. [11] [12] Las pandemias y sus finales no están bien definidos, y si una ha terminado o no difiere según la definición utilizada. [11] [13] Al 29 de septiembre de 2024, COVID-19 ha causado 7.065.867 [5] muertes confirmadas. La pandemia de COVID-19 se ubica como la quinta pandemia o epidemia más mortal de la historia .
En epidemiología , una pandemia se define como «una epidemia que se produce en una zona muy amplia, que cruza fronteras internacionales y que suele afectar a un gran número de personas». Durante la pandemia de COVID-19, al igual que con otras pandemias, el significado de este término ha sido cuestionado. [14]
El fin de una pandemia u otra epidemia rara vez implica la desaparición total de una enfermedad y, históricamente, se ha prestado mucha menos atención a definir el fin de las epidemias que a su comienzo. El fin de determinadas epidemias se ha definido de diversas maneras, según el campo académico y según la ubicación y el grupo social. El fin de una epidemia puede considerarse un fenómeno social, no solo biológico. [13]
En marzo de 2024, la revista Time informó que las opiniones de los expertos difieren sobre si la COVID-19 se considera endémica o pandémica, y que la OMS sigue llamando pandemia a la enfermedad en su sitio web. [15]
Nombres de virus
Durante el brote inicial en Wuhan , el virus y la enfermedad se denominaban comúnmente "coronavirus", "coronavirus de Wuhan", [16] "el brote de coronavirus" y el "brote de coronavirus de Wuhan", [17] y la enfermedad a veces se denominaba " neumonía de Wuhan ". [18] [19] En enero de 2020, la OMS recomendó 2019-nCoV [20] y enfermedad respiratoria aguda 2019-nCoV [21] como nombres provisionales para el virus y la enfermedad según las directrices internacionales de 2015 contra el uso de ubicaciones geográficas (por ejemplo, Wuhan, China), especies animales o grupos de personas en los nombres de enfermedades y virus, en parte para prevenir el estigma social . [22] La OMS finalizó los nombres oficiales COVID-19 y SARS-CoV-2 el 11 de febrero de 2020. [23] Tedros Adhanom Ghebreyesus explicó: CO para corona , VI para virus , D para enfermedad y 19 para cuando se identificó por primera vez el brote (31 de diciembre de 2019). [24] La OMS también utiliza "el virus COVID-19" y "el virus responsable de COVID-19" en las comunicaciones públicas. [23]
La OMS nombró las variantes preocupantes y las variantes de interés utilizando letras griegas . La práctica inicial de nombrarlas según el lugar donde se identificaron las variantes (por ejemplo, Delta comenzó como la " variante india ") ya no es común. [25] Un esquema de nombres más sistemático refleja el linaje PANGO de la variante (por ejemplo, el linaje de Omicron es B.1.1.529) y se utiliza para otras variantes. [26] [27] [28]
El consenso científico es que lo más probable es que el virus sea de origen zoonótico , de murciélagos u otro mamífero estrechamente relacionado. [37] [40] [41] Si bien se han propuesto otras explicaciones, como especulaciones de que el SARS-CoV-2 se liberó accidentalmente de un laboratorio , [42] [43] [44] a partir de 2021, estas no estaban respaldadas por evidencia. [45]
Casos
Los recuentos oficiales de "casos" se refieren al número de personas a las que se les ha hecho la prueba de COVID-19 y cuyo resultado ha sido confirmado positivo según los protocolos oficiales, independientemente de que hayan experimentado o no la enfermedad sintomática. [46] [47] Debido al efecto del sesgo de muestreo , los estudios que obtienen un número más preciso extrapolando a partir de una muestra aleatoria han encontrado sistemáticamente que el total de infecciones supera considerablemente el recuento de casos notificados. [48] [49] Muchos países, al principio, tenían políticas oficiales de no realizar pruebas a quienes solo presentaban síntomas leves. [50] [51] Los factores de riesgo más importantes para una enfermedad grave son la obesidad, las complicaciones de la diabetes , los trastornos de ansiedad y el número total de afecciones. [52]
Al comienzo de la pandemia de COVID-19 no estaba claro si los jóvenes tenían menos probabilidades de infectarse o de desarrollar síntomas y ser examinados. [53] Un estudio de cohorte retrospectivo en China encontró que los niños y los adultos tenían la misma probabilidad de infectarse. [54]
Entre los estudios más exhaustivos, los resultados preliminares del 9 de abril de 2020 encontraron que en Gangelt , el centro de un importante grupo de infecciones en Alemania, el 15 por ciento de una muestra de población dio positivo en la prueba de anticuerpos . [55] Las pruebas de detección de COVID-19 en mujeres embarazadas en la ciudad de Nueva York y donantes de sangre en los Países Bajos encontraron tasas de pruebas de anticuerpos positivas que indicaban más infecciones de las notificadas. [56] [57] Las estimaciones basadas en la seroprevalencia son conservadoras, ya que algunos estudios muestran que las personas con síntomas leves no tienen anticuerpos detectables. [58]
Las estimaciones iniciales del número básico de reproducción (R 0 ) para la COVID-19 en enero de 2020 estaban entre 1,4 y 2,5, [59] pero un análisis posterior afirmó que podría ser de alrededor de 5,7 (con un intervalo de confianza del 95 por ciento de 3,8 a 8,9). [60]
En diciembre de 2021, el número de casos siguió aumentando debido a varios factores, incluidas las nuevas variantes de la COVID-19. Hasta ese 28 de diciembre, se había confirmado la infección de 282.790.822 personas en todo el mundo. [61] Al 14 de abril de 2022 [update], se habían confirmado más de 500 millones de casos en todo el mundo. [62] La mayoría de los casos no están confirmados; el Instituto de Métricas y Evaluación de la Salud estima que el número real de casos a principios de 2022 se sitúa en los miles de millones. [63] [64]
Gráfico semilogarítmico de los nuevos casos semanales de COVID-19 en el mundo y los seis principales países en 2022
Tasa de positividad de la prueba
Una medida que utilizan los funcionarios de salud pública y los encargados de formular políticas para monitorear la pandemia y orientar la toma de decisiones es la tasa de positividad de las pruebas ("porcentaje positivo"). Según Johns Hopkins en 2020, un parámetro de referencia para un porcentaje positivo "demasiado alto" es el 5%, que fue utilizado por la OMS en el pasado. [65] Al final del período de informe de cuatro semanas del 22 de julio al 18 de agosto de 2024, la OMS informó que el porcentaje de positividad semanal de las pruebas de PCR del SARS-CoV-2 fue del 10,2%. [66]
Fallecidos
El fallecido en una "morgue móvil" refrigerada fuera de un hospital en Hackensack, Nueva Jersey , EE. UU., en abril de 2020Sepultureros entierran el cuerpo de un hombre sospechoso de haber muerto por COVID-19 en el cementerio de Vila Alpina, zona este de São Paulo , en abril de 2020.Exceso mundial y reportado de muertes por COVID-19 y muertes por cada 100.000, según el estudio de la OMS [67]
Hasta el 10 de marzo de 2023, se habían atribuido más de 6,88 millones [8] de muertes a la COVID-19. La primera muerte confirmada se produjo en Wuhan el 9 de enero de 2020. [68] Estas cifras varían según la región y a lo largo del tiempo, y están influidas por el volumen de pruebas, la calidad del sistema sanitario, las opciones de tratamiento, la respuesta del gobierno, [69] el tiempo transcurrido desde el brote inicial y las características de la población, como la edad, el sexo y la salud general. [70]
Se utilizan múltiples medidas para cuantificar la mortalidad. [71] Los recuentos oficiales de muertes suelen incluir a las personas que murieron después de dar positivo en la prueba. Dichos recuentos excluyen las muertes sin prueba. [72] Por el contrario, se pueden incluir las muertes de personas que murieron por enfermedades subyacentes después de una prueba positiva. [73] Países como Bélgica incluyen las muertes de casos sospechosos, incluidos los que no se realizaron la prueba, lo que aumenta los recuentos. [74]
Se ha afirmado que los recuentos oficiales de muertes subestiman la cifra real de muertes, porque los datos de exceso de mortalidad (el número de muertes en un período en comparación con un promedio a largo plazo) muestran un aumento de las muertes que no se explica solo por las muertes por COVID-19. [75] Utilizando esos datos, las estimaciones del número real de muertes por COVID-19 en todo el mundo han incluido un rango de 18,2 a 33,5 millones (≈27,4 millones) para el 18 de noviembre de 2023 por The Economist , [7] [75] así como más de 18,5 millones para el 1 de abril de 2023 por el Instituto de Métricas y Evaluación de la Salud [76] y ≈18,2 millones (anteriormente) de muertes entre el 1 de enero de 2020 y el 31 de diciembre de 2021, según un estudio internacional exhaustivo. [77] Esas muertes incluyen muertes debidas a limitaciones y prioridades de la capacidad sanitaria, así como a la renuencia a buscar atención (para evitar una posible infección). [78] Investigaciones futuras podrían ayudar a distinguir las proporciones causadas directamente por la COVID-19 de aquellas causadas por consecuencias indirectas de la pandemia. [77]
En mayo de 2022, la OMS estimó que el número de muertes excedentes para fines de 2021 era de 14,9 millones, en comparación con los 5,4 millones de muertes por COVID-19 notificadas; se cree que la mayoría de las 9,5 millones de muertes no notificadas fueron muertes directas debido al virus, en lugar de muertes indirectas. Algunas muertes se debieron a que personas con otras afecciones no pudieron acceder a los servicios médicos . [79] [80]
Un estudio de la OMS de diciembre de 2022 estimó el exceso de muertes por la pandemia durante 2020 y 2021, y nuevamente concluyó que se produjeron aproximadamente 14,8 millones de muertes prematuras en exceso, reafirmando y detallando sus cálculos anteriores de mayo y actualizándolos, respondiendo a las críticas. Estas cifras no incluyen medidas como los años de vida potencial perdidos y pueden hacer que la pandemia sea la principal causa de muerte en 2021. [81] [82] [67]
El tiempo transcurrido entre la aparición de los síntomas y la muerte varía entre 6 y 41 días, normalmente unos 14 días. [83] Las tasas de mortalidad aumentan en función de la edad. Las personas con mayor riesgo de mortalidad son los ancianos y aquellos con enfermedades subyacentes. [84] [85]
Gráfico semilogarítmico de muertes semanales por COVID-19 en el mundo y los seis principales países actuales (media con casos)
Exceso de muertes en relación con las muertes esperadas (Los patrones indican la calidad de los datos de mortalidad por todas las causas que estaban disponibles para cada país respectivo.) [67]
Exceso de muertes en relación con las muertes esperadas (global y regional de la OMS) [67]
Los 25 países con el mayor exceso de muertes totales estimadas por la pandemia de COVID-19 entre enero de 2020 y diciembre de 2021 [67]
Los 25 países con las puntuaciones P medias más altas (exceso de muertes en relación con las muertes esperadas) [67]
Tasa de letalidad por infección (IFR)
La tasa de letalidad por infección (IFR) es el número acumulado de muertes atribuidas a la enfermedad dividido por el número acumulado de individuos infectados (incluyendo infecciones asintomáticas y no diagnosticadas y excluyendo individuos infectados vacunados). [87] [88] [89] Se expresa en puntos porcentuales. [90] Otros estudios se refieren a esta métrica como el riesgo de letalidad por infección . [91] [92]
En noviembre de 2020, un artículo de revisión en Nature informó estimaciones de las tasas de mortalidad por infarto ponderadas por población para varios países, excluyendo las muertes en centros de atención para ancianos, y encontró un rango medio de 0,24% a 1,49%. [93] Las tasas de mortalidad por infarto aumentan en función de la edad (de 0,002% a los 10 años y 0,01% a los 25 años, a 0,4% a los 55 años, 1,4% a los 65 años, 4,6% a los 75 años y 15% a los 85 años). Estas tasas varían en un factor de ≈10 000 entre los grupos de edad. [86] A modo de comparación, la tasa de mortalidad por infarto para adultos de mediana edad es dos órdenes de magnitud mayor que el riesgo anualizado de un accidente automovilístico fatal y mucho mayor que el riesgo de morir de influenza estacional . [86]
En diciembre de 2020, una revisión sistemática y un metanálisis estimaron que la tasa de letalidad ponderada por población era del 0,5% al 1% en algunos países (Francia, Países Bajos, Nueva Zelanda y Portugal), del 1% al 2% en otros países (Australia, Inglaterra, Lituania y España) y de alrededor del 2,5% en Italia. Este estudio informó que la mayoría de las diferencias reflejaban diferencias correspondientes en la estructura etaria de la población y el patrón específico de edad de las infecciones. [86] También ha habido revisiones que han comparado la tasa de letalidad de esta pandemia con pandemias anteriores, como la del MERS-CoV. [94]
A modo de comparación, la tasa de mortalidad por infección de gripe estacional en Estados Unidos es del 0,1%, lo que es 13 veces menor que la de la COVID-19. [95]
Tasa de letalidad (CFR)
Otra métrica para evaluar la tasa de mortalidad es la tasa de letalidad (CFR), [a] que es la relación entre muertes y diagnósticos. Esta métrica puede ser engañosa debido al retraso entre la aparición de los síntomas y la muerte y porque las pruebas se centran en las personas sintomáticas. [96]
Según las estadísticas de la Universidad Johns Hopkins , la tasa de letalidad global fue del 1,02 por ciento (6.881.955 muertes por 676.609.955 casos) al 10 de marzo de 2023. [8] La cifra varía según la región y, en general, ha disminuido con el tiempo. [97]
Enfermedad
Variantes
La OMS ha nombrado varias variantes y las ha etiquetado como variante de preocupación (VoC) o variante de interés (VoI). Muchas de estas variantes comparten la variante D614G más infecciosa . A mayo de 2023, la OMS había rebajado todas las variantes de preocupación a circulantes anteriormente, ya que ya no se detectaban en nuevas infecciones. [98] [99] La OMS consideró que los sublinajes de la variante ómicron (BA.1 – BA.5) eran VoC independientes hasta que se rebajaron en marzo de 2023 por no circular ampliamente. [99] A 24 de septiembre de 2024 [update], las variantes de interés especificadas por la Organización Mundial de la Salud son BA.2.86 y JN.1, y las variantes bajo seguimiento son JN.1.7, KP.2, KP.3, KP.3.1.1, JN.1.18, LB.1 y XEC. [100]
Los síntomas de la COVID-19 son variables y van desde síntomas leves hasta una enfermedad grave. [103] [104] Los síntomas comunes incluyen dolor de cabeza, pérdida del olfato y el gusto , congestión nasal y secreción nasal , tos, dolor muscular , dolor de garganta , fiebre, diarrea y dificultades respiratorias . [103] Las personas con la misma infección pueden tener síntomas diferentes y sus síntomas pueden cambiar con el tiempo. Se han identificado tres grupos comunes de síntomas: un grupo de síntomas respiratorios con tos, esputo , dificultad para respirar y fiebre; un grupo de síntomas musculoesqueléticos con dolor muscular y articular, dolor de cabeza y fatiga; un grupo de síntomas digestivos con dolor abdominal, vómitos y diarrea. [105] En personas sin trastornos previos de oído, nariz y garganta, la pérdida del gusto combinada con la pérdida del olfato se asocia con la COVID-19 y se informa en hasta el 88% de los casos. [106] [107] [108]
Transmisión
La enfermedad se transmite principalmente por vía respiratoria cuando las personas inhalan gotitas y pequeñas partículas suspendidas en el aire (que forman un aerosol ) que las personas infectadas exhalan al respirar, hablar, toser, estornudar o cantar. [109] [110] [111] [112] Las personas infectadas tienen más probabilidades de transmitir la COVID-19 cuando están físicamente cerca de otras personas no infectadas. Sin embargo, la infección puede producirse a distancias más largas, en particular en interiores. [109] [113]
El SARS-CoV-2 pertenece a la amplia familia de virus conocidos como coronavirus . [114] Es un virus de ARN monocatenario (+ssRNA) de polaridad positiva, con un solo segmento de ARN lineal. Los coronavirus infectan a los seres humanos, a otros mamíferos, incluidos el ganado y los animales de compañía, y a las especies aviares. [115]
Los coronavirus humanos pueden causar enfermedades que van desde el resfriado común hasta enfermedades más graves como el síndrome respiratorio de Oriente Medio (MERS, tasa de mortalidad ≈34%). El SARS-CoV-2 es el séptimo coronavirus conocido que infecta a personas, después del 229E , NL63 , OC43 , HKU1 , MERS-CoV y el SARS-CoV original . [116]
Diagnóstico
Una enfermera en la estación McMurdo instala el equipo de prueba de reacción en cadena de la polimerasa (PCR), en septiembre de 2020.
El método estándar para detectar la presencia del SARS-CoV-2 es una prueba de ácido nucleico [117] , que detecta la presencia de fragmentos de ARN viral [118] . Como estas pruebas detectan el ARN pero no el virus infeccioso, su "capacidad para determinar la duración de la infectividad de los pacientes es limitada". [119] La prueba se realiza normalmente en muestras respiratorias obtenidas mediante un hisopo nasofaríngeo ; sin embargo, también se puede utilizar un hisopo nasal o una muestra de esputo [120] [121] La OMS ha publicado varios protocolos de prueba para la enfermedad [122] .
Prevención
Medidas comunes implementadas para prevenir la propagación del virus
Las medidas preventivas para reducir las posibilidades de infección incluyen vacunarse, quedarse en casa o pasar más tiempo al aire libre, evitar lugares concurridos, mantener la distancia de los demás, usar mascarilla en público, ventilar los espacios interiores, gestionar la posible duración de la exposición, lavarse las manos con agua y jabón con frecuencia y durante al menos veinte segundos, practicar una buena higiene respiratoria y evitar tocarse los ojos, la nariz o la boca con las manos sin lavar. [123] [124]
Las autoridades sanitarias recomiendan a las personas diagnosticadas con COVID-19 o que creen que pueden estar infectadas que se queden en casa excepto para recibir atención médica, llamen antes de visitar a un proveedor de atención médica, usen una mascarilla antes de ingresar al consultorio del proveedor de atención médica y, cuando estén en cualquier habitación o vehículo con otra persona, cubran la tos y los estornudos con un pañuelo, se laven las manos regularmente con agua y jabón y eviten compartir artículos personales del hogar. [125] [126] [127]
Vacunas
Una mujer mayor recibe la vacuna contra la COVID-19 en Eslovaquia
La vacuna contra la COVID-19 tiene como objetivo proporcionar inmunidad adquirida contra el coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2), el virus que causa la enfermedad por coronavirus 2019 ( COVID-19 ). Antes de la pandemia de COVID-19, existía un conjunto establecido de conocimientos sobre la estructura y la función de los coronavirus que causan enfermedades como el síndrome respiratorio agudo severo (SARS) y el síndrome respiratorio de Oriente Medio (MERS). Este conocimiento aceleró el desarrollo de varias plataformas de vacunas a principios de 2020. [128] El enfoque inicial de las vacunas contra el SARS-CoV-2 fue prevenir la enfermedad sintomática y grave. [129] Las vacunas contra la COVID-19 son ampliamente reconocidas por su papel en la reducción de la gravedad y la muerte causadas por la COVID-19. [130] [131]
En marzo de 2023, más de 5500 millones de personas habían recibido una o más dosis [132] (11 800 millones en total) en más de 197 países. La vacuna de Oxford-AstraZeneca fue la más utilizada. [133] Según un estudio de junio de 2022, las vacunas contra la COVID-19 evitaron entre 14,4 y 19,8 millones de muertes adicionales en 185 países y territorios entre el 8 de diciembre de 2020 y el 8 de diciembre de 2021. [134] [135]
El 8 de noviembre de 2022 se autorizó el uso en adultos de la primera vacuna contra la COVID-19 basada en proteínas recombinantes ( Nuvaxovid de Novavax ), que posteriormente recibió la aprobación/autorización de la OMS, los EE. UU., la Unión Europea y Australia. [136] [137]
El 12 de noviembre de 2022, la OMS publicó su Informe sobre el mercado mundial de vacunas. En el informe se indica que “la distribución desigual no es exclusiva de las vacunas contra la COVID-19”; los países que no son económicamente fuertes tienen dificultades para obtener vacunas. [138]
El 14 de noviembre de 2022 se presentó la primera vacuna inhalable, desarrollada por la empresa biofarmacéutica china CanSino Biologics , en la ciudad de Shanghái, China. [139]
Durante los dos primeros años de la pandemia, no se disponía de ningún tratamiento o cura específicos y eficaces. [140] [141] En 2021, el Comité de Medicamentos de Uso Humano (CHMP) de la Agencia Europea de Medicamentos (EMA) aprobó el inhibidor de la proteasa antiviral oral Paxlovid (nirmatrelvir más el antiviral contra el VIH ritonavir ), para tratar a pacientes adultos. [142] Posteriormente, la FDA le otorgó una EUA. [143]
La mayoría de los casos de COVID-19 son leves. En estos casos, el tratamiento de apoyo incluye medicación como paracetamol o AINE para aliviar los síntomas (fiebre, [144] dolores corporales, tos), ingesta adecuada de líquidos por vía oral y descanso. [141] [145] También se recomienda una buena higiene personal y una dieta saludable . [146]
La gravedad de la COVID-19 varía. Puede tener un curso leve con pocos o ningún síntoma, similar a otras enfermedades comunes de las vías respiratorias superiores, como el resfriado común . En el 3-4% de los casos (7,4% para los mayores de 65 años) los síntomas son lo suficientemente graves como para causar hospitalización. [155] Los casos leves suelen recuperarse en dos semanas, mientras que aquellos con enfermedades graves o críticas pueden tardar de tres a seis semanas en recuperarse. Entre los que han fallecido, el tiempo desde el inicio de los síntomas hasta la muerte ha oscilado entre dos y ocho semanas. El tiempo de protrombina prolongado y los niveles elevados de proteína C reactiva al ingreso al hospital se asocian con un curso grave de la COVID-19 y con un traslado a unidades de cuidados intensivos (UCI). [156] [157]
Entre el 5% y el 50% de los pacientes con COVID-19 experimentan COVID prolongada , [158] una condición caracterizada por consecuencias a largo plazo que persisten después del período típico de convalecencia de la enfermedad. [159] [160] Las presentaciones clínicas notificadas con mayor frecuencia son fatiga y problemas de memoria, así como malestar general, dolores de cabeza, dificultad para respirar , pérdida del olfato, debilidad muscular , fiebre baja y disfunción cognitiva . [161] [162] [163] [164]
Estrategias
Los objetivos de mitigación incluyen retrasar y reducir la carga máxima en la atención médica ( aplanar la curva ) y disminuir los casos generales y el impacto en la salud. [165] [166] Además, aumentos progresivamente mayores en la capacidad de atención médica ( elevar la línea ), como por ejemplo aumentando el número de camas, el personal y el equipo, ayudan a satisfacer la mayor demanda. [167]
Muchos países intentaron frenar o detener la propagación de la COVID-19 recomendando, ordenando o prohibiendo cambios de comportamiento, mientras que otros se basaron principalmente en proporcionar información. Las medidas iban desde avisos públicos hasta confinamientos estrictos. Las estrategias de control de brotes se dividen en eliminación y mitigación. Los expertos diferencian entre estrategias de eliminación (conocidas como " COVID cero ") que tienen como objetivo detener por completo la propagación del virus dentro de la comunidad, [168] y estrategias de mitigación (comúnmente conocidas como " aplanamiento de la curva ") que intentan disminuir los efectos del virus en la sociedad, pero que aún toleran cierto nivel de transmisión dentro de la comunidad. [169] Estas estrategias iniciales pueden llevarse a cabo de forma secuencial o simultánea durante la fase de inmunidad adquirida a través de la inmunidad natural e inducida por la vacuna . [170]
En 2021, Nature informó que el 90 por ciento de los investigadores que respondieron a una encuesta "creen que el coronavirus se volverá endémico ". [171]
Contención
La contención se lleva a cabo para evitar que un brote se propague a la población general. Las personas infectadas se aíslan mientras son infecciosas. Las personas con las que han interactuado son contactadas y aisladas durante el tiempo suficiente para garantizar que no estén infectadas o que ya no sean contagiosas. El cribado es el punto de partida para la contención. El cribado se realiza comprobando los síntomas para identificar a las personas infectadas, a las que se puede aislar o se les puede ofrecer tratamiento. [172] La estrategia de cero COVID implica el uso de medidas de salud pública como el rastreo de contactos , las pruebas masivas , la cuarentena fronteriza , los cierres y el software de mitigación para detener la transmisión comunitaria de COVID-19 tan pronto como se detecte, con el objetivo de que la zona vuelva a tener cero infecciones detectadas y se reanuden las actividades económicas y sociales normales. [168] [173] La contención o supresión exitosa reduce Rt a menos de 1. [174]
Mitigación
Si la contención falla, los esfuerzos se centran en la mitigación: medidas adoptadas para frenar la propagación y limitar sus efectos en el sistema de atención sanitaria y la sociedad. La mitigación exitosa retrasa y reduce el pico de la epidemia, lo que se conoce como "aplanamiento de la curva epidémica ". [165] Esto reduce el riesgo de saturar los servicios de salud y proporciona más tiempo para desarrollar vacunas y tratamientos. [165] El comportamiento individual cambió en muchas jurisdicciones. Muchas personas trabajaron desde casa en lugar de en sus lugares de trabajo tradicionales. [175]
Intervenciones no farmacéuticas
Los CDC y la OMS recomiendan que las mascarillas (como la que usa aquí la presidenta taiwanesa, Tsai Ing-wen ) reduzcan la propagación del SARS-CoV-2.
Las intervenciones no farmacéuticas que pueden reducir la propagación incluyen acciones personales como el uso de mascarillas , la autocuarentena y la higiene de manos ; medidas comunitarias destinadas a reducir los contactos interpersonales, como el cierre de lugares de trabajo y escuelas y la cancelación de grandes reuniones; la participación de la comunidad para alentar la aceptación y participación en dichas intervenciones; así como medidas ambientales como la limpieza de superficies. [176]
Otras medidas
En varias jurisdicciones se han intentado medidas más drásticas, como la cuarentena de poblaciones enteras y prohibiciones estrictas de viajes. [177] Las estrategias de los gobiernos chino y australiano han incluido muchos confinamientos y se consideran ampliamente las más estrictas. La respuesta del gobierno de Nueva Zelanda incluyó las restricciones de viaje más severas. Como parte de su programa K-Quarantine , Corea del Sur introdujo exámenes masivos y cuarentenas localizadas, y emitió alertas sobre los movimientos de personas infectadas. La respuesta del gobierno de Singapur incluyó los llamados " confinamientos de disyuntor " y apoyo financiero para los afectados, al tiempo que impuso grandes multas para quienes incumplieran la cuarentena. [178]
Rastreo de contactos
El rastreo de contactos intenta identificar contactos recientes de personas recién infectadas y examinarlas para detectar la infección; el enfoque tradicional es solicitar una lista de contactos de las personas infectadas y luego llamar por teléfono o visitar a los contactos. [179] El rastreo de contactos se utilizó ampliamente durante la epidemia del virus del Ébola en África occidental en 2014. [180]
Otro enfoque es recopilar datos de ubicación de dispositivos móviles para identificar a quienes han estado en contacto significativo con personas infectadas, lo que generó preocupaciones sobre la privacidad. [181] El 10 de abril de 2020, Google y Apple anunciaron una iniciativa para el rastreo de contactos que preserva la privacidad. [182] [183] En Europa y en los EE. UU., Palantir Technologies proporcionó inicialmente servicios de seguimiento de COVID-19. [184]
Cuidado de la salud
La OMS describió el aumento de la capacidad y la adaptación de la atención de salud como una mitigación fundamental. [185] El ECDC y la oficina regional europea de la OMS emitieron directrices para hospitales y servicios de atención primaria de salud para trasladar recursos en múltiples niveles, incluyendo centrar los servicios de laboratorio hacia las pruebas, cancelar procedimientos electivos, separar y aislar a los pacientes y aumentar las capacidades de cuidados intensivos mediante la capacitación del personal y el aumento de los respiradores y las camas. [185] [186] La pandemia impulsó la adopción generalizada de la telesalud . [187]
Debido a las limitaciones de capacidad de la cadena de suministro , algunos fabricantes comenzaron a imprimir en 3D material como hisopos nasales y piezas de respiradores. [188] [189] En un ejemplo, una startup italiana recibió amenazas legales debido a una supuesta infracción de patente después de realizar ingeniería inversa e imprimir cien válvulas de respirador solicitadas durante la noche. [190] Los individuos y grupos de fabricantes crearon y compartieron diseños de código abierto y dispositivos de fabricación utilizando materiales de origen local, costura e impresión 3D. Se fabricaron millones de protectores faciales , batas protectoras y máscaras. Otros suministros médicos ad hoc incluyeron cubrezapatos, gorras quirúrgicas, respiradores purificadores de aire motorizados y desinfectante de manos . Se crearon dispositivos novedosos como protectores de oídos , cascos de ventilación no invasiva y divisores de respiradores. [191]
Inmunidad de grupo
En julio de 2021, varios expertos expresaron su preocupación por la posibilidad de que no fuera posible lograr la inmunidad colectiva porque la variante delta puede transmitirse entre personas vacunadas. [192] Los CDC publicaron datos que mostraban que las personas vacunadas podían transmitir la variante delta, algo que los funcionarios creían que era menos probable con otras variantes. En consecuencia, la OMS y los CDC alentaron a las personas vacunadas a continuar con las intervenciones no farmacéuticas, como el uso de mascarillas, el distanciamiento social y la cuarentena en caso de exposición. [193]
Historia
2019
El brote se descubrió en Wuhan en noviembre de 2019. Es posible que la transmisión entre humanos estuviera ocurriendo antes del descubrimiento. [37] [38] Según un análisis retrospectivo que comenzó en diciembre de 2019, el número de casos en Hubei aumentó gradualmente, llegando a 60 el 20 de diciembre y al menos a 266 el 31 de diciembre. [194]
El 26 de diciembre se observó un brote de neumonía , que fue tratado por la neumóloga china Zhang Jixian . Ella informó al CDC de Wuhan Jianghan el 27 de diciembre. [195] Después de analizar muestras de pacientes con neumonía, una empresa de secuenciación genética llamada Vision Medicals informó el descubrimiento de un nuevo coronavirus al CDC de China (CCDC) el 28 de diciembre. [196] [197]
El 30 de diciembre, un informe de prueba de CapitalBio Medlab dirigido al Hospital Central de Wuhan informó un resultado positivo erróneo de SARS , lo que hizo que los médicos de allí alertaran a las autoridades. Ocho de esos médicos, incluido Li Wenliang (que también fue castigado el 3 de enero), fueron posteriormente amonestados por la policía por difundir rumores falsos. El director del Departamento de Emergencias del Hospital Central de Wuhan, Ai Fen, también fue reprendido. [198] [199] Esa tarde, la Comisión Municipal de Salud de Wuhan (WMHC) emitió un aviso sobre "el tratamiento de la neumonía de causa desconocida". [200] Al día siguiente, WMHC hizo público el anuncio, confirmando 27 casos [201] [202] —suficientes para desencadenar una investigación. [203]
El 31 de diciembre, la oficina de la OMS en China fue notificada sobre el grupo de casos de neumonía desconocidos [204] [201] e inmediatamente inició una investigación. [203]
Fuentes oficiales chinas afirmaron que los primeros casos estaban relacionados principalmente con el mercado mayorista de mariscos de Huanan, que también vendía animales vivos. [205] En mayo de 2020, el director del CCDC, George Gao, descartó inicialmente el mercado como posible origen, ya que las muestras de animales recolectadas allí habían dado negativo. [206]
2020
Señal de tráfico que desalienta los viajes en Toronto , marzo de 2020
El 11 de enero, la Comisión Nacional de Salud de China notificó a la OMS que el brote estaba asociado con exposiciones en el mercado y que China había identificado un nuevo tipo de coronavirus, que aisló el 7 de enero. [204]
Inicialmente, el número de casos se duplicó aproximadamente cada siete días y medio. [207] A principios y mediados de enero, el virus se propagó a otras provincias chinas , ayudado por la migración del Año Nuevo chino . Wuhan era un centro de transporte y un importante intercambiador ferroviario. [208] El 10 de enero, el genoma del virus se compartió públicamente. [209] Un estudio retrospectivo publicado en marzo encontró que 6.174 personas habían informado síntomas hasta el 20 de enero. [210] Un informe del 24 de enero indicó que probablemente se estaba produciendo transmisión humana y recomendó equipo de protección personal para los trabajadores de la salud. También abogó por la realización de pruebas, dado el "potencial pandémico" del brote. [211] [212] El 31 de enero, el primer estudio de modelado publicado advirtió sobre inevitables "brotes independientes autosostenibles en las principales ciudades del mundo" y pidió "intervenciones de salud pública a gran escala". [213]
El 30 de enero se habían confirmado 7.818 infecciones, lo que llevó a la OMS a declarar el brote como una emergencia de salud pública de importancia internacional (ESPII). [214] [215] [216] El 11 de marzo, la OMS anunció su evaluación de que la situación podía caracterizarse como una pandemia. [3]
El 31 de enero, Italia indicó que se habían producido sus primeras infecciones confirmadas, en dos turistas procedentes de China. [217] El 19 de marzo, Italia superó a China como el país con más muertes notificadas. [218] El 26 de marzo, Estados Unidos había superado a China e Italia como el país con el mayor número de infecciones confirmadas. [219] El análisis genómico indicó que la mayoría de las infecciones confirmadas en Nueva York procedían de Europa, en lugar de directamente de Asia. [220] Las pruebas de muestras anteriores revelaron una persona que se infectó en Francia el 27 de diciembre de 2019 [221] [222] y una persona en los Estados Unidos que murió a causa de la enfermedad el 6 de febrero. [223]
En octubre, la OMS informó que una de cada diez personas en el mundo podría haber sido infectada, o 780 millones de personas, mientras que solo se habían confirmado 35 millones de infecciones. [224]
El 9 de noviembre, Pfizer publicó los resultados de los ensayos de una vacuna candidata, que mostraban una eficacia del 90 por ciento en la prevención de infecciones. Ese día, Novavax presentó una solicitud de aprobación rápida de la FDA para su vacuna. [225] [226]
El 14 de diciembre, Public Health England informó que se había descubierto una variante en el sureste del Reino Unido, predominantemente en Kent . La variante, posteriormente denominada Alpha , mostró cambios en la proteína de pico que podrían hacer que el virus fuera más infeccioso. Hasta el 13 de diciembre, se habían confirmado 1108 infecciones en el Reino Unido. [227] [228]
El 4 de febrero de 2020, el Secretario de Salud y Servicios Humanos de Estados Unidos, Alex Azar, eximió de responsabilidad a los fabricantes de vacunas en todos los casos, excepto aquellos que implicaban “mala conducta deliberada”. [229] [230]
2021
El 2 de enero, la variante Alpha , descubierta por primera vez en el Reino Unido, se había identificado en 33 países. [231] El 6 de enero, la variante Gamma se identificó por primera vez en viajeros japoneses que regresaban de Brasil. [232] El 29 de enero, se informó que la vacuna Novavax tuvo una eficacia del 49 por ciento contra la variante Beta en un ensayo clínico en Sudáfrica. [233] [234] Se informó que la vacuna CoronaVac tuvo una eficacia del 50,4 por ciento en un ensayo clínico en Brasil. [235]
Un hospital temporal para pacientes con COVID-19 en Brasil en marzo de 2021
El 12 de marzo, varios países dejaron de utilizar la vacuna Oxford-AstraZeneca contra la COVID-19 debido a problemas de coagulación sanguínea, específicamente trombosis de los senos venosos cerebrales (TSVC). [236] El 20 de marzo, la OMS y la Agencia Europea de Medicamentos no encontraron ningún vínculo con la trombosis , lo que llevó a varios países a reanudar la administración de la vacuna. [237] En marzo, la OMS informó que un huésped animal era el origen más probable, sin descartar otras posibilidades. [2] [36] La variante Delta se identificó por primera vez en la India. A mediados de abril, la variante se detectó por primera vez en el Reino Unido y dos meses después se había convertido en una tercera ola en toda regla en el país, lo que obligó al gobierno a retrasar la reapertura que originalmente estaba programada para junio. [238]
El 10 de noviembre, Alemania desaconsejó la vacuna Moderna para personas menores de 30 años, debido a una posible asociación con miocarditis . [239] El 24 de noviembre, se detectó la variante Ómicron en Sudáfrica; unos días después, la Organización Mundial de la Salud la declaró VoC (variante preocupante). [240] La nueva variante es más infecciosa que la variante Delta. [241]
2022
Micrografía electrónica de barrido (coloreada) de una célula infectada con la cepa Omicron del virus SARS-CoV-2, partículas verdes
El 1 de enero, Europa superó los 100 millones de casos en medio de un aumento de la variante ómicron . [242] Más tarde ese mes, la OMS recomendó el medicamento para la artritis reumatoide Baricitinib para pacientes graves o críticos. También recomendó el anticuerpo monoclonal Sotrovimab en pacientes con enfermedad no grave, pero solo en aquellos que corren el mayor riesgo de hospitalización. [243]
El 24 de enero, el Instituto de Métricas y Evaluación de la Salud estimó que alrededor del 57% de la población mundial había sido infectada por COVID-19. [63] [64] Para el 6 de marzo, se informó que el recuento total de muertes en todo el mundo había superado los 6 millones de personas. [244] Para el 6 de julio, las subvariantes ómicron BA.4 y BA.5 se habían extendido por todo el mundo. [245] El Director General de la OMS, Tedros Ghebreyesus, declaró el 14 de septiembre de 2022 que "[El mundo] nunca ha estado en mejor posición para poner fin a la pandemia", citando el número más bajo de muertes semanales reportadas desde marzo de 2020. Continuó: "Aún no hemos llegado allí. Pero el final está a la vista: podemos ver la línea de meta". [246] [247] [248] [249]
El 21 de octubre, Estados Unidos superó los 99 millones de casos de COVID-19, la mayor cantidad de casos de cualquier país. [250] Para el 30 de octubre, el número de muertes diarias en todo el mundo era de 424, el más bajo desde que se informaron 385 muertes el 12 de marzo de 2020. [251] El 17 de noviembre se cumplió el tercer aniversario desde que los funcionarios de salud en China detectaron por primera vez el COVID-19. [252]
El 11 de noviembre, la OMS informó que las muertes desde el mes de febrero habían disminuido en un 90 por ciento. El Director General Tedros dijo que esto era "motivo de optimismo". [253] El 3 de diciembre, la OMS indicó que "al menos el 90 por ciento de la población mundial tiene algún nivel de inmunidad al Sars-CoV-2". [254] A principios de diciembre, China comenzó a levantar algunas de sus medidas de confinamiento más estrictas. Datos posteriores de las autoridades sanitarias chinas revelaron que 248 millones de personas, casi el 18 por ciento de su población, habían sido infectadas en los primeros 20 días de ese mes. [255] El 29 de diciembre, Estados Unidos se unió a Italia, Japón, Taiwán e India al exigir resultados negativos de la prueba de COVID-19 a todas las personas que viajaran desde China debido al nuevo aumento de casos. La UE rechazó medidas similares, afirmando que la variante ómicron BF7 ya se había extendido por toda Europa sin llegar a ser dominante. [256] [257]
2023
El 4 de enero de 2023, la Organización Mundial de la Salud afirmó que la información compartida por China durante el reciente aumento de infecciones carecía de datos, como las tasas de hospitalización. [258] El 10 de enero, la oficina europea de la OMS afirmó que el reciente aumento del virus en China no representaba "ninguna amenaza inmediata". [259] El 16 de enero, la OMS recomendó que China vigilara el exceso de mortalidad para proporcionar "una comprensión más completa del impacto de la COVID-19". [260]
El 30 de enero, tercer aniversario de la declaración original, la Organización Mundial de la Salud determinó que la COVID-19 todavía cumplía los criterios para ser una emergencia de salud pública de importancia internacional (ESPII). [261]
El 19 de marzo, el Director General de la OMS, Tedros, indicó que estaba "seguro" de que la pandemia de COVID-19 dejaría de ser una emergencia de salud pública a finales de año. [262] El 5 de mayo, la OMS degradó la COVID-19 de ser una emergencia sanitaria mundial, aunque siguió refiriéndose a ella como una pandemia. [263] La OMS no hace declaraciones oficiales sobre cuándo terminan las pandemias. [4] [264] La decisión se tomó después de que Tedros se reuniera con el Comité de Emergencia del Reglamento Sanitario Internacional, en el que el Comité señaló que debido a la disminución de las muertes y las hospitalizaciones, y la prevalencia de las vacunaciones y el nivel de inmunidad general, era hora de eliminar la designación de emergencia y "hacer la transición a una gestión a largo plazo". [265] Tedros estuvo de acuerdo, y la OMS redujo la clasificación a un "problema de salud establecido y en curso". [265] En una conferencia de prensa, Tedros señaló que la disminución de la amenaza del COVID-19 había “permitido a la mayoría de los países volver a la vida como la conocíamos antes del COVID-19”. [266]
En septiembre, la OMS afirmó que había observado tendencias "preocupantes" en el número de casos de COVID-19 y de hospitalizaciones, aunque el análisis se vio obstaculizado porque muchos países ya no registraban las estadísticas de casos de COVID-19. [267]
En noviembre de 2023, en respuesta a las mutaciones virales y las características cambiantes de la infección, la OMS ajustó sus pautas de tratamiento. Entre otros cambios, el remdesivir y el molnupiravir ahora se recomiendan solo para los casos más graves, y se desaconseja el deuremidevir y la ivermectina. [268]
Respuestas
Las reacciones nacionales variaron desde confinamientos estrictos hasta campañas de educación pública. [269] La OMS recomendó que los toques de queda y los confinamientos fueran medidas a corto plazo para reorganizar, reagrupar, reequilibrar los recursos y proteger el sistema de atención de la salud. [270] Al 26 de marzo de 2020, 1.700 millones de personas en todo el mundo estaban bajo alguna forma de confinamiento. [271] Esta cifra aumentó a 3.900 millones de personas en la primera semana de abril, más de la mitad de la población mundial . [272] [273]
En varios países aumentaron las protestas contra restricciones como los confinamientos. Un estudio de febrero de 2021 concluyó que las protestas contra las restricciones probablemente aumentarían directamente la propagación del virus. [274]
Asia
A finales de 2021, el pico en Asia se había producido al mismo tiempo y al mismo nivel que en el mundo en su conjunto, en mayo de 2021. [275] Sin embargo, en conjunto habían experimentado solo la mitad del promedio mundial de casos. [276]
China optó por la contención, instituyendo estrictos confinamientos para eliminar la propagación viral. [277] [278] Las vacunas distribuidas en China incluyeron la BIBP , WIBP y CoronaVac . [279] El 11 de diciembre de 2021 se informó que China había vacunado a 1.162 millones de sus ciudadanos, o el 82,5% de la población total del país contra la COVID-19. [280] La adopción a gran escala de la estrategia cero-COVID por parte de China había contenido en gran medida las primeras oleadas de infecciones de la enfermedad. [277] [281] [282] Cuando siguieron las oleadas de infecciones debidas a la variante Ómicron , China estaba casi sola en la aplicación de la estrategia de cero-Covid para combatir la propagación del virus en 2022. [283] En noviembre se siguió empleando el confinamiento para combatir una nueva oleada de casos; [284] [285] Sin embargo, estallaron protestas en ciudades de toda China por las estrictas medidas del país, [286] [287] y en diciembre de ese año, el país relajó su política de cero COVID. [288] El 20 de diciembre de 2022, el Consejo de Estado chino redujo su definición de lo que se contabilizaría como una muerte por COVID-19 para incluir únicamente la insuficiencia respiratoria, lo que provocó escepticismo por parte de los expertos en salud sobre el recuento total de muertes del gobierno [289] [290] en un momento en que los hospitales informaron estar abrumados por los casos tras la interrupción abrupta de la política de cero COVID. [291]
El primer caso en la India se informó el 30 de enero de 2020. La India ordenó un confinamiento nacional a partir del 24 de marzo de 2020, [292] con un desbloqueo gradual a partir del 1 de junio de 2020. Seis ciudades representaron alrededor de la mitad de los casos notificados: Mumbai , Delhi , Ahmedabad , Chennai , Pune y Calcuta . [293] Después del confinamiento, el Gobierno de la India introdujo una aplicación de seguimiento de contactos llamada Aarogya Setu para ayudar a las autoridades a gestionar el rastreo de contactos y la distribución de vacunas. [294] El programa de vacunación de la India se consideró el más grande y exitoso del mundo, con más del 90% de los ciudadanos recibiendo la primera dosis y otro 65% recibiendo la segunda dosis. [295] [296] Una segunda ola golpeó a la India en abril de 2021, tensionando los servicios de salud. [297] El 21 de octubre de 2021, se informó que el país había superado los mil millones de vacunaciones. [298]
Desinfección de los trenes del metro de Teherán para prevenir la transmisión de COVID-19. Se han tomado medidas similares en otros países. [299]
Irán informó de sus primeros casos confirmados el 19 de febrero de 2020, en Qom . [300] [301] Las primeras medidas incluyeron la cancelación o cierre de conciertos y otros eventos culturales, [302] las oraciones del viernes, [303] y los campus escolares y universitarios. [304] Irán se convirtió en un centro de la pandemia en febrero de 2020. [305] [306] Más de diez países habían rastreado sus brotes hasta Irán hasta el 28 de febrero, lo que indica un brote más grave que los 388 casos notificados. [306] [307] El Parlamento iraní cerró, después de que 23 de sus 290 miembros dieran positivo el 3 de marzo de 2020. [308] Al menos doce políticos y funcionarios gubernamentales iraníes en ejercicio o anteriores habían muerto hasta el 17 de marzo de 2020. [309] En agosto de 2021, la quinta ola de la pandemia alcanzó su punto máximo, con más de 400 muertes en un día. [310]
El 20 de enero de 2020 se confirmó la COVID-19 en Corea del Sur. Las bases militares fueron puestas en cuarentena después de que las pruebas mostraran que tres soldados estaban infectados. [311] Corea del Sur introdujo lo que entonces se consideraba el programa de detección más grande y mejor organizado del mundo, que aislaba a las personas infectadas y rastreaba y ponía en cuarentena a los contactos. [312] Los métodos de detección incluían la autodeclaración obligatoria por parte de los recién llegados internacionales a través de una aplicación móvil, [313] combinada con pruebas desde el automóvil , [314] y el aumento de la capacidad de prueba a 20.000 personas al día. [315] A pesar de algunas críticas iniciales, [316] el programa de Corea del Sur se consideró un éxito en el control del brote sin poner en cuarentena ciudades enteras. [312] [317] [318]
Europa
Muertes por cada 100.000 habitantes
La pandemia de COVID-19 llegó a Europa con su primer caso confirmado en Burdeos , Francia , el 24 de enero de 2020, y posteriormente se extendió ampliamente por todo el continente. Para el 17 de marzo de 2020, todos los países de Europa habían confirmado un caso, [319] y todos habían informado al menos una muerte, con la excepción de la Ciudad del Vaticano . Italia fue la primera nación europea en experimentar un brote importante a principios de 2020, convirtiéndose en el primer país del mundo en introducir un confinamiento nacional . [320] Para el 13 de marzo de 2020, la Organización Mundial de la Salud (OMS) declaró a Europa como el epicentro de la pandemia [321] [322] y permaneció así hasta que la OMS anunció que había sido superada por Sudamérica el 22 de mayo. [323] Para el 18 de marzo de 2020, más de 250 millones de personas estaban confinadas en Europa. [324] A pesar del despliegue de las vacunas contra la COVID-19 , Europa volvió a convertirse en el epicentro de la pandemia a finales de 2021. [325] [326]
El brote italiano comenzó el 31 de enero de 2020, cuando dos turistas chinos dieron positivo en la prueba del SARS-CoV-2 en Roma. [217] Los casos comenzaron a aumentar drásticamente, lo que llevó al gobierno a suspender los vuelos hacia y desde China y declarar el estado de emergencia. [327] El 22 de febrero de 2020, el Consejo de Ministros anunció un nuevo decreto-ley para contener el brote, que puso en cuarentena a más de 50.000 personas en el norte de Italia. [328] El 4 de marzo, el gobierno italiano ordenó el cierre de escuelas y universidades cuando Italia alcanzó el centenar de muertes. El deporte se suspendió por completo durante al menos un mes. [329] El 11 de marzo, el primer ministro italiano Giuseppe Conte cerró casi toda la actividad comercial, excepto supermercados y farmacias. [330] [331] El 19 de abril, la primera ola remitió, ya que las muertes en siete días se redujeron a 433. [332] El 13 de octubre, el gobierno italiano volvió a emitir normas restrictivas para contener la segunda ola. [333] El 10 de noviembre, Italia superó el millón de infecciones confirmadas. [334] El 23 de noviembre, se informó que la segunda ola del virus había llevado a algunos hospitales a dejar de aceptar pacientes. [335]
La primera vez que se confirmó que el virus se había propagado a España fue el 31 de enero de 2020, cuando un turista alemán dio positivo en la prueba del SARS-CoV-2 en La Gomera, en las Islas Canarias. [336] El análisis genético post hoc ha demostrado que se habían importado al menos 15 cepas del virus y que la transmisión comunitaria comenzó a mediados de febrero. [337] El 29 de marzo, se anunció que, a partir del día siguiente, se ordenaría a todos los trabajadores no esenciales que permanecieran en casa durante los siguientes 14 días. [338] El número de casos volvió a aumentar en julio en varias ciudades, entre ellas Barcelona , Zaragoza y Madrid , lo que llevó a la reimposición de algunas restricciones, pero no a un confinamiento nacional. [339] [340] [341] [342] En septiembre de 2021, España era uno de los países con mayor porcentaje de población vacunada (76% totalmente vacunada y 79% con la primera dosis). [343] Italia ocupa el segundo lugar con un 75%. [343]
Suecia se diferenciaba de la mayoría de los demás países europeos en que permaneció mayoritariamente abierta. [344] Según la constitución sueca , la Agencia de Salud Pública de Suecia tiene una autonomía que impide la interferencia política y la agencia estaba a favor de permanecer abierta. La estrategia sueca se centró en medidas a más largo plazo, basándose en el supuesto de que después del confinamiento el virus volvería a propagarse, con el mismo resultado. [345] [346] A finales de junio, Suecia ya no tenía exceso de mortalidad . [347]
La descentralización en el Reino Unido significó que cada uno de sus cuatro países desarrolló su propia respuesta. Las restricciones de Inglaterra duraron menos que las de los demás. [348] El gobierno del Reino Unido comenzó a aplicar medidas de distanciamiento social y cuarentena el 18 de marzo de 2020. [349] [350] El 16 de marzo, el primer ministro Boris Johnson desaconsejó los viajes no esenciales y el contacto social, elogió el trabajo desde casa y evitó lugares como pubs, restaurantes y teatros. [351] [352] El 20 de marzo, el gobierno ordenó el cierre de todos los establecimientos de ocio, [353] y prometió prevenir el desempleo. [354] El 23 de marzo, Johnson prohibió las reuniones y restringió los viajes no esenciales y la actividad al aire libre. A diferencia de las medidas anteriores, estas restricciones eran ejecutables por la policía mediante multas y dispersión de reuniones. Se ordenó el cierre de la mayoría de los negocios no esenciales. [355] El 24 de abril de 2020, se informó de que se había iniciado un prometedor ensayo de vacuna en Inglaterra; El gobierno prometió más de 50 millones de libras esterlinas para la investigación. [356] El 16 de abril de 2020, se informó de que el Reino Unido tendría el primer acceso a la vacuna de Oxford, debido a un contrato previo; si el ensayo tuviera éxito, estarían disponibles unos 30 millones de dosis. [357] El 2 de diciembre de 2020, el Reino Unido se convirtió en el primer país desarrollado en aprobar la vacuna Pfizer; 800.000 dosis estaban inmediatamente disponibles para su uso. [358] En agosto de 2022 se informó de que los casos de infección viral habían disminuido en el Reino Unido. [359]
América del norte
El virus llegó a los Estados Unidos el 13 de enero de 2020. [360] Se notificaron casos en todos los países de América del Norte después de que Saint Kitts y Nevis confirmara un caso el 25 de marzo, y en todos los territorios de América del Norte después de que Bonaire confirmara un caso el 16 de abril. [361]
Según Our World in Data , en Estados Unidos se han notificado 103 436 829 [5] casos confirmados y 1 200 360 [5] muertes, la mayor cantidad de cualquier país y la decimonovena tasa per cápita más alta del mundo. [362] La COVID-19 es la pandemia más mortal en la historia de Estados Unidos ; [363] fue la tercera causa de muerte en Estados Unidos en 2020, detrás de las enfermedades cardíacas y el cáncer. [364] De 2019 a 2020, la esperanza de vida en Estados Unidos se redujo en 3 años para los hispanoamericanos, 2,9 años para los afroamericanos y 1,2 años para los estadounidenses blancos. [365] Estos efectos han persistido, ya que las muertes en Estados Unidos por COVID-19 en 2021 superaron a las de 2020. [366] En Estados Unidos, las vacunas contra la COVID-19 estuvieron disponibles bajo uso de emergencia en diciembre de 2020, lo que dio inicio al programa nacional de vacunación . La primera vacuna contra la COVID-19 fue aprobada oficialmente por la Administración de Alimentos y Medicamentos el 23 de agosto de 2021. [367] Para el 18 de noviembre de 2022, si bien los casos en los EE. UU. habían disminuido, las variantes de COVID BQ.1/BQ.1.1 se habían vuelto dominantes en el país. [368] [369]
En marzo de 2020, cuando se confirmaron casos de transmisión comunitaria en todo Canadá , todas sus provincias y territorios declararon estados de emergencia. Las provincias y territorios, en diversos grados, implementaron cierres de escuelas y guarderías, prohibiciones de reuniones, cierres de negocios no esenciales y restricciones a la entrada. Canadá restringió severamente su acceso fronterizo, prohibiendo a los viajeros de todos los países con algunas excepciones. [370] Los casos aumentaron en todo Canadá, especialmente en las provincias de Columbia Británica , Alberta , Quebec y Ontario , con la formación de la Burbuja del Atlántico , una zona del país con restricciones de viajes (formada por las cuatro provincias del Atlántico ). [371] Se adoptaron pasaportes de vacunación en todas las provincias y dos de los territorios. [372] [373] Según un informe del 11 de noviembre de 2022, las autoridades sanitarias canadienses observaron un aumento de la gripe, mientras que se esperaba que la COVID-19 aumentara durante el invierno. [374]
Sudamerica
Desinfección de área pública en Itapevi , Brasil, en abril de 2020
The COVID-19 pandemic was confirmed to have reached South America on 26 February 2020, when Brazil confirmed a case in São Paulo.[375] By 3 April, all countries and territories in South America had recorded at least one case.[376] On 13 May 2020, it was reported that Latin America and the Caribbean had reported over 400,000 cases of COVID-19 infection with 23,091 deaths. On 22 May 2020, citing the rapid increase of infections in Brazil, the World Health Organization WHO declared South America the epicentre of the pandemic.[377][378] As of 16 July 2021, South America had recorded 34,359,631 confirmed cases and 1,047,229 deaths from COVID-19. Due to a shortage of testing and medical facilities, it is believed that the outbreak is far larger than the official numbers show.[379]
The virus was confirmed to have spread to Brazil on 25 February 2020,[380] when a man from São Paulo who had traveled to Italy tested positive for the virus.[381] The disease had spread to every federative unit of Brazil by 21 March. On 19 June 2020, the country reported its one millionth case and nearly 49,000 reported deaths.[382][383] One estimate of under-reporting was 22.62% of total reported COVID-19 mortality in 2020.[384][385][386] As of 29 September 2024, Brazil, with 37,511,921[5] confirmed cases and 702,116[5] deaths, has the third-highest number of confirmed cases and second-highest death toll from COVID-19 in the world, behind only those of the United States and India.[387]
Africa
US Air Force personnel unload a C-17 aircraft carrying medical supplies in Niamey, Niger, in April 2020.
The COVID-19 pandemic was confirmed to have spread to Africa on 14 February 2020, with the first confirmed case announced in Egypt.[388][389] The first confirmed case in sub-Saharan Africa was announced in Nigeria at the end of February 2020.[390] Within three months, the virus had spread throughout the continent; Lesotho, the last African sovereign state to have remained free of the virus, reported its first case on 13 May 2020.[391][392] By 26 May, it appeared that most African countries were experiencing community transmission, although testing capacity was limited.[393] Most of the identified imported cases arrived from Europe and the United States rather than from China where the virus originated.[394] Many preventive measures were implemented by different countries in Africa including travel restrictions, flight cancellations, and event cancellations.[395] Despite fears, Africa reported lower death rates than other, more economically developed regions.[396]
In early June 2021, Africa faced a third wave of COVID infections with cases rising in 14 countries.[397] By 4 July the continent recorded more than 251,000 new COVID cases, a 20% increase from the prior week and a 12% increase from the January peak. More than sixteen African countries, including Malawi and Senegal, recorded an uptick in new cases.[398] The World Health Organization labelled it Africa's 'Worst Pandemic Week Ever'.[399] In October 2022, WHO reported that most countries on the African continent will miss the goal of 70 percent vaccination by the end of 2022.[400]
Oceania
Empty shelves at a Coles grocery store in Brisbane, Australia, in April 2020
The COVID-19 pandemic was confirmed to have reached Oceania on 25 January 2020, with the first confirmed case reported in Melbourne, Australia.[401][402] It has since spread elsewhere in the region.[403][402]Australia and New Zealand were praised for their handling of the pandemic in comparison to other Western nations, with New Zealand and each state in Australia wiping out all community transmission of the virus several times even after re-introduction into the community.[404][405][406]
As a result of the high transmissibility of the Delta variant, however, by August 2021, the Australian states of New South Wales and Victoria had conceded defeat in their eradication efforts.[407] In early October 2021, New Zealand also abandoned its elimination strategy.[408] In November and December, following vaccination efforts, the remaining states of Australia, excluding Western Australia, voluntarily gave up COVID-Zero to open up state and international borders.[409][410][411] The open borders allowed the Omicron variant of COVID-19 to enter quickly, and cases subsequently exceeded 120,000 a day.[412] By early March 2022, with cases exceeding 1,000 a day, Western Australia conceded defeat in its eradication strategy and opened its borders.[413] Despite record cases, Australian jurisdictions slowly removed restrictions such as close contact isolation, mask wearing, and density limits by April 2022.[414]
On 9 September 2022, restrictions were significantly relaxed. The aircraft mask mandate was scrapped nationwide, and daily reporting transitioned to weekly reporting.[415][416][417] On 14 September, COVID-19 disaster payment for isolating persons was extended for mandatory isolation.[418] By 22 September, all states had ended mask mandates on public transport, including in Victoria, where the mandate had lasted for approximately 800 days.[419] On 30 September 2022, all Australian leaders declared the emergency response finished and announced the end of isolation requirements. These changes were due in part to high levels of 'hybrid immunity' and low case numbers.[420]
Antarctica
Due to its remoteness and sparse population, Antarctica was the last continent to have confirmed cases of COVID-19.[421][422][423] The first cases were reported in December 2020, almost a year after the first cases of COVID-19 were detected in China. At least 36 people were infected in the first outbreak in 2020,[424] with several other outbreaks taking place in 2021 and 2022.[425]
United Nations
The United Nations Conference on Trade and Development (UNSC) was criticised for its slow response, especially regarding the UN's global ceasefire, which aimed to open up humanitarian access to conflict zones.[426][427] The United Nations Security Council was criticized due to the inadequate manner in which it dealt with the COVID-19 pandemic, namely the poor ability to create international collaboration during this crisis.[428][429]
On 23 March 2020, United Nations Secretary-General António Manuel de Oliveira Guterres appealed for a global ceasefire;[430][431] 172 UN member states and observers signed a non-binding supporting statement in June,[432] and the UN Security Council passed a resolution supporting it in July.[433][434]
On 29 September 2020, Guterres urged the International Monetary Fund to help certain countries via debt relief and also call for countries to increase contributions to develop vaccines.[435]
Donated medical supplies received in the Philippines
The pandemic shook the world's economy, with especially severe economic damage in the United States, Europe and Latin America.[438][439] A consensus report by American intelligence agencies in April 2021 concluded, "Efforts to contain and manage the virus have reinforced nationalist trends globally, as some states turned inward to protect their citizens and sometimes cast blame on marginalized groups." COVID-19 inflamed partisanship and polarisation around the world as bitter arguments exploded over how to respond. International trade was disrupted amid the formation of no-entry enclaves.[440]
Travel restrictions
The pandemic led many countries and regions to impose quarantines, entry bans, or other restrictions, either for citizens, recent travellers to affected areas,[441] or for all travellers.[442][443] Travel collapsed worldwide, damaging the travel sector. The effectiveness of travel restrictions was questioned as the virus spread across the world.[444] One study found that travel restrictions only modestly affected the initial spread, unless combined with other infection prevention and control measures.[445][446] Researchers concluded that "travel restrictions are most useful in the early and late phase of an epidemic" and "restrictions of travel from Wuhan unfortunately came too late".[447] The European Union rejected the idea of suspending the Schengen free travel zone.[448][449]
Repatriation of foreign citizens
Ukraine evacuates Ukrainian citizens from Wuhan, China.
Several countries repatriated their citizens and diplomatic staff from Wuhan and surrounding areas, primarily through charter flights. Canada, the United States, Japan, India, Sri Lanka, Australia, France, Argentina, Germany and Thailand were among the first to do so.[450] Brazil and New Zealand evacuated their own nationals and others.[451][452] On 14 March, South Africa repatriated 112 South Africans who tested negative, while four who showed symptoms were left behind.[453] Pakistan declined to evacuate its citizens.[454]
On 15 February, the US announced it would evacuate Americans aboard the Diamond Princess cruise ship,[455] and on 21 February, Canada evacuated 129 Canadians from the ship.[456] In early March, the Indian government began repatriating its citizens from Iran.[457][458] On 20 March, the United States began to withdraw some troops from Iraq.[459]
The pandemic and responses to it damaged the global economy. On 27 February 2020, worries about the outbreak crushed US stock indexes, which posted their sharpest falls since 2008.[460]
Tourism collapsed due to travel restrictions, closing of public places including travel attractions, and advice of governments against travel. Airlines cancelled flights, while British regional airline Flybe collapsed.[461] The cruise line industry was hard hit,[462] and train stations and ferry ports closed.[463] International mail stopped or was delayed.[464]
The retail sector faced reductions in store hours or closures.[465] Retailers in Europe and Latin America faced traffic declines of 40 percent. North America and Middle East retailers saw a 50–60 percent drop.[466] Shopping centres faced a 33–43 percent drop in foot traffic in March compared to February. Mall operators around the world coped by increasing sanitation, installing thermal scanners to check the temperature of shoppers, and cancelling events.[467]
Hundreds of millions of jobs were lost,[468][469] including more than 40 million jobs in the US.[470] According to a report by Yelp, about 60% of US businesses that closed will stay shut permanently.[471] The International Labour Organization (ILO) reported that the income generated in the first nine months of 2020 from work across the world dropped by 10.7 percent, or $3.5 trillion.[472]
Supply shortages
COVID-19 fears led to panic buying of essentials across the world, including toilet paper, instant noodles, bread, rice, vegetables, disinfectant, and rubbing alcohol (picture taken in February 2020).
Pandemic fears led to panic buying, emptying groceries of essentials such as food, toilet paper, and bottled water. Panic buying stemmed from perceived threat, perceived scarcity, fear of the unknown, coping behaviour and social psychological factors (e.g. social influence and trust).[473]
Supply shortages were due to disruption to factory and logistic operations; shortages were worsened by supply chain disruptions from factory and port shutdowns, and labour shortages.[474]
Shortages continued as managers underestimated the speed of economic recovery after the initial economic crash. The technology industry, in particular, warned of delays from underestimates of semiconductor demand for vehicles and other products.[475]
According to WHO Secretary-General Tedros Ghebreyesus, demand for personal protective equipment (PPE) rose one hundredfold, pushing prices up twentyfold.[476][477] PPE stocks were exhausted everywhere.[478][479][480]
In September 2021, the World Bank reported that food prices remained generally stable and the supply outlook remained positive. However, the poorest countries witnessed a sharp increase in food prices, reaching the highest level since the pandemic began.[481][482] The Agricultural Commodity Price Index stabilized in the third quarter but remained 17% higher than in January 2021.[483][482]
By contrast, petroleum products were in surplus at the beginning of the pandemic, as demand for gasoline and other products collapsed due to reduced commuting and other trips.[484] The 2021 global energy crisis was driven by a global surge in demand as the world economy recovered. Energy demand was particularly strong in Asia.[485][486]
Arts and cultural heritage
The performing arts and cultural heritage sectors were profoundly affected by the pandemic. Both organisations' and individuals' operations have been impacted globally. By March 2020, across the world and to varying degrees, museums, libraries, performance venues, and other cultural institutions had been indefinitely closed with their exhibitions, events and performances cancelled or postponed.[487] A 2021 UNESCO report estimated ten million job losses worldwide in the culture and creative industries.[488][489] Some services continued through digital platforms,[490][491][492] such as live streaming concerts[493] or web-based arts festivals.[494]
Politics
The pandemic affected political systems, causing suspensions of legislative activities,[495] isolations or deaths of politicians,[496] and rescheduled elections.[497] Although they developed broad support among epidemiologists, NPIs (non-pharmaceutical interventions) were controversial in many countries. Intellectual opposition came primarily from other fields, along with heterodox epidemiologists.[498]
Brazil
The pandemic (and the response of Brazilian politicians to it) led to widespread panic, confusion, and pessimism in Brazil.[499] When questioned regarding record deaths in the country in April 2020, Brazilian President Jair Bolsonaro said "So what? I'm sorry. What do you want me to do about it?"[500] Bolsonaro disregarded WHO-recommended mitigation techniques and instead downplayed the risks of the virus, promoted increased economic activity, spread misinformation about the efficacy of masks, vaccines and public health measures, and distributed unproven treatments including hydroxychloroquine and ivermectin.[499] A series of federal health ministers resigned or were dismissed after they refused to implement Bolsonaro's policies.[501]
Disagreements between federal and state governments led to a chaotic and delayed response to the rapid spread of the virus,[502] exacerbated by preexisting social and economic disparities in the country.[499][503] Employment, investment and valuation of the Brazilian real plummeted to record lows.[499][504] Brazil was also heavily affected by the Delta and Omicron variants.[505] At the height of the outbreak in the spring of 2021, 3,000+ Brazilians were dying per day.[506][507] Bolsonaro's loss to Lula da Silva in the 2022 presidential election is widely credited to the former's mishandling of the pandemic.[508][509][510]
China
Multiple provincial-level administrators of the Chinese Communist Party (CCP) were dismissed over their handling of quarantine measures. Some commentators claimed this move was intended to protect CCP General Secretary Xi Jinping.[511] The US intelligence community claimed that China intentionally under-reported its COVID-19 caseload.[512] The Chinese government maintained that it acted swiftly and transparently.[513][514] Journalists and activists in China who reported on the pandemic were detained by authorities,[515][516] including Zhang Zhan, who was arrested and tortured.[517][518]
Italy
Palazzo Margherita lit in Italian flag to show solidarity during the COVID-19 pandemic on 26 March 2020
In early March 2020, the Italian government criticised the EU's lack of solidarity with Italy.[519][520][521] On 22 March 2020, after a phone call with Italian Prime Minister Giuseppe Conte, Russian President Vladimir Putin ordered the Russian army to send military medics, disinfection vehicles, and other medical equipment to Italy.[522][523] In early April, Norway and EU states like Romania and Austria started to offer help by sending medical personnel and disinfectant,[524] and European Commission President Ursula von der Leyen offered an official apology to the country.[525]
Beginning in mid-April 2020, protestors objected to government-imposed business closures and restrictions on personal movement and assembly.[527] Simultaneously, essential workers protested unsafe conditions and low wages by participating in a brief general strike.[528] Some political analysts claimed that the pandemic contributed to President Donald Trump's 2020 defeat.[529][530]
There were also protest in regards to vaccine mandates in the United States.[535] In January 2022, the US Supreme Court struck down an OSHA rule that mandated vaccination or a testing regimen for all companies with greater than 100 employees.[536][537]
Other countries
The number of journalists imprisoned or detained increased worldwide; some detentions were related to the pandemic.[538][539] The planned NATO "Defender 2020" military exercise in Germany, Poland and the Baltic states, the largest NATO war exercise since the end of the Cold War, was held on a reduced scale.[540][541]
The Iranian government was heavily affected by the virus, which infected some two dozen parliament members and political figures.[307][542] Iran President Hassan Rouhani wrote a public letter to world leaders asking for help on 14 March 2020, due to a lack of access to international markets.[543] Saudi Arabia, which had launched a military intervention in Yemen in March 2015, declared a ceasefire.[544]
Diplomatic relations between Japan and South Korea worsened.[545] South Korea criticised Japan's "ambiguous and passive quarantine efforts" after Japan announced travellers from South Korea must quarantine for two weeks.[546] South Korean society was initially polarised on President Moon Jae-in's response to the crisis; many Koreans signed petitions calling for Moon's impeachment or praising his response.[316]
Some countries passed emergency legislation. Some commentators expressed concern that it could allow governments to strengthen their grip on power.[547][548] In Hungary, the parliament voted to allow Prime Minister Viktor Orbán to rule by decree indefinitely, suspend parliament and elections, and punish those deemed to have spread false information.[549] In countries such as Egypt,[550]Turkey,[551] and Thailand,[552] opposition activists and government critics were arrested for allegedly spreading fake news.[553] In India, journalists criticising the government's response were arrested or issued warnings by police and authorities.[554]
Food systems
The pandemic disrupted food systems worldwide,[555][556] hitting at a time when hunger and undernourishment were rising- an estimated 690 million people lacked food security in 2019.[557] Food access fell – driven by falling incomes, lost remittances, and disruptions to food production.[558] In some cases, food prices rose.[555][557] The pandemic and its accompanying lockdowns and travel restrictions slowed movement of food aid. According to the WHO, 811 million people were undernourished in 2020, "likely related to the fallout of COVID-19".[559][439]
Education
Students take end-of-year exams in Tabriz, Iran, during the pandemic.
The pandemic impacted educational systems in many countries. Many governments temporarily closed educational institutions, often replaced by online education. Other countries, such as Sweden, kept their schools open. As of September 2020, approximately 1.077 billion learners were affected due to school closures. School closures impacted students, teachers, and families with far-reaching economic and societal consequences.[560] They shed light on social and economic issues, including student debt, digital learning, food insecurity, and homelessness, as well as access to childcare, health care, housing, internet, and disability services. The impact was more severe for disadvantaged children.[561] The Higher Education Policy Institute reported that around 63% of students claimed worsened mental health as a result of the pandemic.[562]
Health
The pandemic impacted global health for many conditions. Hospital visits fell.[563] Visits for heart attack symptoms declined by 38% in the US and 40% in Spain.[564] The head of cardiology at the University of Arizona said, "My worry is some of these people are dying at home because they're too scared to go to the hospital."[565] People with strokes and appendicitis were less likely to seek treatment.[566][567][565]Medical supply shortages impacted many people.[568] The pandemic impacted mental health,[569][570] increasing anxiety, depression, and post-traumatic stress disorder, affecting healthcare workers, patients and quarantined individuals.[571][572]
In late 2022, during the first northern hemisphere autumn and winter seasons following the widespread relaxation of global public health measures, North America and Europe experienced a surge in respiratory viruses and coinfections in both adults and children.[573] This formed the beginning of the 2022–2023 pediatric care crisis and what some experts termed a "tripledemic" of seasonal influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 throughout North America.[574][575] In the United Kingdom, pediatric infections also began to spike beyond pre-pandemic levels, albeit with different illnesses, such as Group A streptococcal infection and resultant scarlet fever.[576][577] As of mid-December 2022, 19 children in the UK had died due to Strep A and the wave of infections had begun to spread into North America and Mainland Europe.[578][579]
The B/Yamagata lineage of influenza B might have become extinct in 2020/2021 due to COVID-19 pandemic measures.[580][581] There have been no naturally occurring cases confirmed since March 2020.[582][583] In 2023, the World Health Organization concluded that protection against the Yamagata lineage was no longer necessary in the seasonal flu vaccine, reducing the number of lineages targeted by the vaccine from four to three.[582][583]
Environment
Images from the NASA Earth Observatory show a stark drop in pollution in Wuhan, when comparing NO2 levels in early 2019 (top) and early 2020 (bottom).[584]
The pandemic and the reaction to it positively affected the environment and climate as a result of reduced human activity. During the "anthropause", fossil fuel use decreased, resource consumption declined, and waste disposal improved, generating less pollution.[585]Planned air travel and vehicle transportation declined. In China, lockdowns and other measures resulted in a 26% decrease in coal consumption, and a 50% reduction in nitrogen oxides emissions.[585][586][587]
In 2020, a worldwide study on mammalian wildlife responses to human presence during COVID lockdowns found complex patterns of animal behavior. Carnivores were generally less active when humans were around, while herbivores in developed areas were more active. Among other findings, this suggested that herbivores may view humans as a shield against predators, highlighting the importance of location and human presence history in understanding wildlife responses to changes in human activity in a given area.[588]
A wide variety of largely mammalian species, both captive and wild, have been shown to be susceptible to SARS-CoV-2, with some encountering a particularly high degree of fatal outcomes.[589] In particular, both farmed and wild mink have developed highly symptomatic and severe COVID-19 infections, with a mortality rate as high as 35–55% according to one study.[590][591]White-tailed deer, on the other hand, have largely avoided severe outcomes but have effectively become natural reservoirs of the virus, with large numbers of free-ranging deer infected throughout the US and Canada, including approximately 80% of Iowa's wild deer herd.[592][593] An August 2023 study appeared to confirm the status of white-tailed deer as a disease reservoir, noting that the viral evolution of SARS-CoV-2 in deer occurs at triple the rate of its evolution in humans and that infection rates remained high, even in areas rarely frequented by humans.[594]
Discrimination and prejudice
A socially distanced homeless encampment in San Francisco, California, in May 2020[595]
Heightened prejudice, xenophobia, and racism toward people of Chinese and East Asian descent were documented around the world.[596][597] Reports from February 2020, when most confirmed cases were confined to China, cited racist sentiments about Chinese people 'deserving' the virus.[598][599][600] Individuals of Asian descent in Europe and North America reported increasing instances of racially-motivated abuse and assaults as a result of the pandemic.[601][602][603] US President Donald Trump was criticised for referring to SARS-CoV-2 as the "Chinese Virus" and "Kung Flu", terms which were condemned as being racist and xenophobic.[604][605][606]
Age-based discrimination against older adults increased during the pandemic. This was attributed to their perceived vulnerability and subsequent physical and social isolation measures, which, coupled with their reduced social activity, increased dependency on others. Similarly, limited digital literacy left the elderly more vulnerable to isolation, depression, and loneliness.[607]
In a correspondence published in The Lancet in 2021, German epidemiologist Günter Kampf described the harmful effects of "inappropriate stigmatisation of unvaccinated people, who include our patients, colleagues, and other fellow citizens", noting the evidence that vaccinated individuals play a large role in transmission.[608] American bioethicist Arthur Caplan responded to Kampf, writing "Criticising [the unvaccinated] who... wind up in hospitals and morgues in huge numbers, put stress on finite resources, and prolong the pandemic... is not stigmatising, it is deserved moral condemnation."[609]
In January 2022, Amnesty International urged Italy to change their anti-COVID-19 restrictions to avoid discrimination against unvaccinated people, saying that "the government must continue to ensure that the entire population can enjoy its fundamental rights." The restrictions included mandatory vaccination over the age of 50, and mandatory vaccination to use public transport.[610]
Lifestyle changes
The "Wee Annie" statue in Gourock, Scotland, was given a face mask during the pandemic.
The pandemic triggered massive changes in behaviour, from increased Internet commerce to cultural changes in the workplace. Online retailers in the US posted $791.70 billion in sales in 2020, an increase of 32.4% from $598.02 billion the year before.[611] Home delivery orders increased, while indoor restaurant dining shut down due to lockdown orders or low sales.[612][613] Hackers, cybercriminals and scammers took advantage of the changes to launch new online attacks.[614]
Education in some countries temporarily shifted from physical attendance to video conferencing.[615] Massive layoffs shrank the airline, travel, hospitality, and other industries.[616][617] Despite most corporations implementing measures to address COVID-19 in the workplace, a poll from Catalyst found that as many as 68% of employees around the world felt that these policies were only performative and "not genuine".[618]
The pandemic led to a surge in remote work. According to a Gallup poll, only 4% of US employees were fully remote before the pandemic, compared to 43% in May 2020. Among white collar workers, that shift was more pronounced, with 6% increasing to 65% in the same period.[619] That trend continued in later stages of the pandemic, with many workers choosing to remain remote even after workplaces reopened.[620][621] Many Nordic, European, and Asian companies increased their recruitment of international remote workers even as the pandemic waned, partially to save on labor costs.[622][623] This also led to a talent drain in the global south and in remote areas in the global north.[623][624] High cost of living and dense urban areas also lost office real estate value due to remote worker exodus.[625] By May 2023, due to increasing layoffs and concerns over productivity, some white collar workplaces in the US had resorted to performance review penalties and indirect incentives (e.g. donations to charity) to encourage workers to return to the office.[626]
Historiography
A 2021 study noted that the COVID-19 pandemic had increased interest in epidemics and infectious diseases among both historians and the general public. Prior to the pandemic, these topics were usually overlooked by "general" history and only received attention in the history of medicine.[627] Many comparisons were made between the COVID-19 and 1918 influenza pandemics,[628][629] including the development of anti-mask movements,[630][631] the widespread promotion of misinformation[632][633] and the impact of socioeconomic disparities.[634]
Religion
An American Catholic military chaplain prepares for a live-streamed Mass in an empty chapel at Offutt Air Force Base in March 2020.
In some areas, religious groups exacerbated the spread of the virus, through large gatherings and the dissemination of misinformation.[635][636][637] Some religious leaders decried what they saw as violations of religious freedom.[638] In other cases, religious identity was a beneficial factor for health, increasing compliance with public health measures and protecting against the negative effects of isolation on mental wellbeing.[639][640][641]
Information dissemination
Some news organizations removed their online paywalls for some or all of their pandemic-related articles and posts.[642] Many scientific publishers provided pandemic-related journal articles to the public free of charge as part of the National Institutes of Health's COVID-19 Public Health Emergency Initiative.[643][644][645] According to one estimate from researchers at the University of Rome, 89.5% of COVID-19-related papers were open access, compared to an average of 48.8% for the ten most deadly human diseases.[646] The share of papers published on preprint servers prior to peer review increased dramatically.[647]
The COVID-19 pandemic had a major impact on popular culture. It was included in the narratives of ongoing pre-pandemic television series and become a central narrative in new ones, with mixed results.[651] Writing for The New York Times about the then-upcoming BBC sitcom Pandemonium on 16 December 2020, David Segal asked, "Are we ready to laugh about Covid-19? Or rather, is there anything amusing, or recognizable in a humorous way, about life during a plague, with all of its indignities and setbacks, not to mention its rituals and rules."[652]
The pandemic had driven some people to seek peaceful escapism in media, while others were drawn towards fictional pandemics (e.g. zombie apocalypses) as an alternate form of escapism.[653] Common themes have included contagion, isolation and loss of control.[654] Many drew comparisons to the fictional film Contagion (2011),[655][656] praising its accuracies while noting some differences,[657] such as the lack of an orderly vaccine rollout.[658][659]
As people turned to music to relieve emotions evoked by the pandemic, Spotify listenership showed that classical, ambient and children's genres grew, while pop, country and dance remained relatively stable.[660][661]
Transition to later phases
A March 2022 review declared a transition to endemic status to be "inevitable".[662] In June 2022, an article in Human Genomics said that the pandemic was still "raging", but that "now is the time to explore the transition from the pandemic to the endemic phase."[663] Another review that month predicted that the virus that causes COVID-19 would become the fifth endemic seasonal coronavirus, alongside four other human coronaviruses.[664]
A February 2023 review of the four common cold coronaviruses concluded that the virus would become seasonal and, like the common cold, cause less severe disease for most people.[665] Another 2023 review stated that the transition to endemic COVID-19 may take years or decades.[666]
On 5 May 2023, the WHO declared that the pandemic was no longer a public health emergency of international concern.[667] This led several media outlets to incorrectly report that this meant the pandemic was "over". The WHO commented to Full Fact that it was unlikely to declare the pandemic over "in the near future" and mentioned cholera, which it considers to have been a pandemic since 1961 (i.e., continuously for the last 63 years).[668] The WHO does not have an official category for pandemics or make declarations of when pandemics start or end.[4][264][669][11]
In June 2023, Hans Kluge, director of the WHO in Europe, commented that "While the international public health emergency may have ended, the pandemic certainly has not". The WHO in Europe launched a transition plan to manage the public health response to COVID-19 in the coming years and prepare for possible future emergencies.[670]
Epidemics and pandemics usually end when the disease becomes endemic, and when the disease becomes "an accepted, manageable part of normal life in a given society."[13] As of March 2024, there was no widely agreed definition of when a disease is or is not a pandemic, though efforts at a formal definition were underway. Experts asked by Time that month noted that COVID-19 continued to circulate and cause disease, but expressed uncertainty as to whether it should still be described as a pandemic.[11]
Long-term effects
Economic
Despite strong economic rebounds following the initial lockdowns in early 2020, towards the latter phases of the pandemic, many countries began to experience long-term economic effects. Several countries saw high inflation rates which had global impacts, particularly in developing countries.[671] Some economic impacts such as supply chain and trade operations were seen as more permanent as the pandemic exposed major weaknesses in these systems.[672]
In Australia, the pandemic caused an increase in occupational burnout in 2022.[673]
During the pandemic, a large percentage of workers in Canada came to prefer working from home, which had an impact on the traditional work model. Some corporations made efforts to force workers to return to work on-site, while some embraced the idea.[674]
Travel
There was a "travel boom" causing air travel to recover at rates faster than anticipated, and the aviation industry became profitable in 2023 for the first time since 2019, before the pandemic.[675] However, economic issues meant some predicted that the boom would begin to slow down.[676] Business travel on airlines was still below pre-pandemic levels and is predicted not to recover.[677]
Health
An increase in excess deaths from underlying causes not related to COVID-19 has been largely blamed on systematic issues causing delays in health care and screening during the pandemic, which has resulted in an increase of non-COVID-19 related deaths.[678]
Immunizations
During the pandemic, millions of children missed out on vaccinations as countries focused efforts on combating COVID-19. Efforts were made to increase vaccination rates among children in low-income countries. These efforts were successful in increasing vaccination rates for some diseases, though the UN noted that post-pandemic measles vaccinations were still falling behind.[679]
Some of the decrease in immunization was driven by an increase in mistrust of public health officials. This was seen in both low-income and high-income countries. Several African countries saw a decline in vaccinations due to misinformation around the pandemic flowing into other areas.[680] Immunization rates have yet to recover in the United States[681] and the United Kingdom.[682]
^Some refer to "fatality rate"; however, "fatality ratio" is more accurate as this is not per unit time.[88]
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Further reading
"Progress report on the coronavirus pandemic". Nature. 584 (7821): 325. August 2020. doi:10.1038/d41586-020-02414-1. PMID 32814893.
Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LF (June 2020). "The trinity of COVID-19: immunity, inflammation and intervention". Nature Reviews. Immunology. 20 (6): 363–374. doi:10.1038/s41577-020-0311-8. PMC 7187672. PMID 32346093.
COVID-19 infection prevention and control measures for primary care, including general practitioner practices, dental clinics and pharmacy settings: first update. European Centre for Disease Prevention and Control (ECDC) (Report). October 2020.
Bar-On YM, Flamholz A, Phillips R, Milo R (April 2020). "SARS-CoV-2 (COVID-19) by the numbers". eLife. 9. arXiv:2003.12886. Bibcode:2020arXiv200312886B. doi:10.7554/eLife.57309. PMC 7224694. PMID 32228860.
Brüssow H (May 2020). "The Novel Coronavirus - A Snapshot of Current Knowledge". Microbial Biotechnology. 13 (3): 607–612. doi:10.1111/1751-7915.13557. PMC 7111068. PMID 32144890.
Cascella M, Rajnik M, Aleem A, Dulebohn S, Di Napoli R (2020). "Features, Evaluation, and Treatment of Coronavirus". StatPearls. StatPearls Publishing. PMID 32150360.
Funk CD, Laferrière C, Ardakani A (2020). "A Snapshot of the Global Race for Vaccines Targeting SARS-CoV-2 and the COVID-19 Pandemic". Frontiers in Pharmacology. 11: 937. doi:10.3389/fphar.2020.00937. PMC 7317023. PMID 32636754.
"Development and Licensure of Vaccines to Prevent COVID-19" (PDF). U.S. Food and Drug Administration (FDA). June 2020.
Birhane M, Bressler S, Chang G, Clark T, Dorough L, Fischer M, et al. (May 2021). "COVID-19 Vaccine Breakthrough Infections Reported to CDC – United States, January 1 – April 30, 2021". MMWR. Morbidity and Mortality Weekly Report. 70 (21): 792–793. doi:10.15585/mmwr.mm7021e3. PMC 8158893. PMID 34043615.
Bieksiene K, Zaveckiene J, Malakauskas K, Vaguliene N, Zemaitis M, Miliauskas S (March 2021). "Post COVID-19 Organizing Pneumonia: The Right Time to Interfere". Medicina. 57 (3): 283. doi:10.3390/medicina57030283. PMC 8003092. PMID 33803690.
Chen Q, Allot A, Lu Z (January 2021). "LitCovid: an open database of COVID-19 literature". Nucleic Acids Research. 49 (D1): D1534–D1540. doi:10.1093/nar/gkaa952. PMC 7778958. PMID 33166392.
Aghagoli G, Gallo Marin B, Katchur NJ, Chaves-Sell F, Asaad WF, Murphy SA (June 2021). "Neurological Involvement in COVID-19 and Potential Mechanisms: A Review". Neurocritical Care. 34 (3): 1062–1071. doi:10.1007/s12028-020-01049-4. PMC 7358290. PMID 32661794.
External links
Scholia has a profile for COVID-19 pandemic (Q81068910).
Health agencies
COVID-19 (Questions & Answers, instructional videos; Facts/MythBusters) by the World Health Organization (WHO)
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